General Surgery Coding Alert

Question: Is there a way to code for vent management in cases such as 1. ARDS immediately post-op after appendectomy for perforation or 2. for post-operative respiratory insufficiency in an 87-year-old patient immediately following repair of perforated gastric ulcer?

Piyush N. Sheth
Ashland, Ohio

Answer: Codes 94656 (ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; first day) and 94657 (subsequent days) are those used for ventilation management, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C. Billing these codes on the same day of a surgery if the patient has developed postoperative complications or new problems unrelated to the surgery would be inappropriate.

Some carriers may require surgeons to attach modifier -24 (unrelated evaluation and management service by the same physician during a postoperative period) to the 94656 and 94657. Some Medicare carriers may consider the service bundled into the procedure if a postoperative complication is being treated. And some carriers may want to know if the ventilation began in the operating room; if so, they may consider it bundled with the surgery, Callaway-Stradley says.